During my community placement, I had seen patients with a wide variety of different conditions and social situations, but one in particular presented quite a dilemma for me.
I visited an elderly gentleman who had a number of medical problems – one of which was heart failure. The only problem being he wasn’t aware of his condition.
- Originally published 6th February 2012
I was relayed the story by the member of staff I was shadowing. Apparently, the family did not want him to know and before I could express feelings of disapproval I was told that I had to “respect their wishes”.
I didn’t know what to say. I didn’t feel confident enough to disagree so I investigated the case further. After reading the patient’s notes I couldn’t see that there was any cognitive impairment or any other legitimate reason why he should not be informed of his own condition. Thankfully another member of staff agreed with me but I still felt uneasy about the situation.
My concerns were not alleviated when it came to the actual visit.
We were there as part of a falls prevention service, so in the member of staff’s defence, I guess she was thinking that because she wasn’t medically trained it wasn’t her place to be imparting that knowledge.
The most awkward moment came when I was reading the past medical history of the patient and the member of staff was in conversation with the man in question. At that moment the partner took the opportunity to walk over to me. She put her arms on either side of me and leant into my ear: “He’s got heart failure but he doesn’t know, okay?” she said in a ‘wink wink’ voice. I felt like a spineless sap as I just sat and nodded. I was pleased when we left.
The whole dynamic left me a little shaken. I had got on well with the patient and found him to be a really pleasant man. He spoke of his fear
of falling and how he thought he was getting better because he was managing to do the occasional leg exercises. I felt guilty at the knowledge I had and wondered how he would be treated for his heart failure without his knowledge.
As a student, I have had lectures on hypothetical situations very similar to this. We were told that our duty is first and foremost to the patient. Unless there was any compelling reason why telling the patient about their own condition would be detrimental then, by all means, the patient should always be well-informed. My only hope is that when I am lucky enough to qualify, I will have the courage to not be complicit simply because it is easier, and instead remember that my patient is always my priority.
